Provider Demographics
NPI:1457671786
Name:HARRIS, CHAVALA MELITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAVALA
Middle Name:MELITA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 NICHOLAS RD STE F
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-3404
Mailing Address - Country:US
Mailing Address - Phone:336-387-9168
Mailing Address - Fax:336-450-1654
Practice Address - Street 1:510 NICHOLAS RD STE F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-3404
Practice Address - Country:US
Practice Address - Phone:336-387-9168
Practice Address - Fax:336-450-1654
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94841223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice